The Financial Clearance Specialist plays a crucial role in ensuring the financial stability of the organization by managing the authorization processes for surgical procedures and patient admissions. This position is responsible for submitting Notices of Admissions (NOA) to payers, securing surgical authorizations, verifying that surgical authorizations are on file, and providing patients with accurate cost estimates for services. The specialist ensures compliance with the No Surprises Act, helping the organization maintain adherence to federal regulations. Obtaining timely and accurate authorization information prior to services reduces claim denials, ensures payer compliance, and improves organizational financial outcomes. Patient experience and provider relations are enhanced through the smooth handling of authorization and estimate processes. This role is key to maintaining smooth patient care operations while safeguarding timely reimbursements from insurers.
Duties and Responsibilities:
1. Request and obtain prior authorizations via insurance carriers or third-party authorization companies, tracking status within CNE’s EHR.
2. Evaluate payer policies to understand authorization and notice of admission requirements.
3. Communicate the status of insurance referrals and prior authorizations with internal departments via the EHR.
4. Complete notifications and insurance verifications for hospital admissions.
5. Ensure compliance with the No Surprises Act.
6. Review estimates with patients prior to services.
7. Assist patients with applying for CNE Charity Care.
8. Connect patients with Financial Counselors for eligibility screening.
9. Document all authorization-related work in CNE’s EHR.
10. Collaborate with internal and external providers to obtain necessary authorization information.
11. Verify insurance details for accuracy to obtain prior authorization.
12. Report issues related to authorization approval to management.
13. Explain relevant notices to patients, such as the Notice of Non-Covered Service Waiver.
14. Monitor EHR queues and work pools throughout the day.
15. Perform other duties as assigned.
Requirements:
* High School diploma or GED required; Associate degree or Medical Assistance certification preferred.
* 5-7 years of healthcare experience.
* At least 3 years of experience with notices of admissions, prior authorizations, or pricing estimates.
About Care New England: Care New England and its member institutions, including Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, are trusted organizations leading medical research and innovative healthcare services.
EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.
Disability and Ethics Statements: Applicants must be able to perform essential functions with or without accommodations. Employees are expected to conduct themselves ethically, consistent with organizational standards.
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